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  • Lead fracture was observed in of leads verified

    2019-05-13

    Lead fracture was observed in 4 of 1092 leads (0.37%); verified and incomplete lead fractures were observed in three (0.27%) and one lead (0.09%), respectively. All these fractures occurred in leads implanted by the SVP method; no fractures were observed in leads implanted by the CVC method (p<0.01) (Fig. 2). An excessive elevation of the atrial pacing threshold occurred in one lead for which the CVC method had been used. The details of the problematic cases are as follows. Case 1 was a 76-year-old man who was implanted with a DDD pacemaker for bradycardia–tachycardia syndrome. When we found the atrial lead fracture, his AF became chronic. Therefore, we changed the pacing mode from DDD to VVI. In cases buy EZ Cap Reagent GG 2 and 3, a DDD device was implanted; we added an atrial new pacing lead. Case 4 was a 12-year-old girl who was implanted with a dual-chamber ICD for long-QT syndrome. Her atrial lead showed incomplete fracture with the lead impedance increasing from 450 to 2000Ω after 8 years of implantation. We changed the pacing mode from DDD to AAI back up to prevent unnecessary ventricular pacing following atrial noise sensing. Case 5 was in 66-year-old man who was implanted with a dual-chamber ICD. We observed an excessively high atrial pacing threshold a year after implantation. Therefore, a new atrial pacing lead was implanted when he required an ICD exchange.
    Discussion The main findings of our study are the following:
    Conclusions
    Conflict of interest
    Introduction The second Multicenter Automatic Defibrillator Implantation Trial (MADIT II) demonstrated in a recent report that an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death (SCD) reduces mortality in patients with a history of myocardial infarction (MI) and left ventricular ejection fraction (LVEF) of ≤30% [1,2] during an extended 8-year follow-up period [3]. However, the significant risks and high cost of ICD therapy have led some to question what kind of patients with low LVEF after MI should receive ICD buy EZ Cap Reagent GG for the primary prevention of SCD without prior ventricular arrhythmic event. Improved risk stratification may identify patients whose ventricular arrhythmic event risk is too low to benefit from ICD implantation. In addition, some reports demonstrated that Asian populations have a lower rate of SCD compared with Caucasians [4]. Therefore, the interest still remains regarding what proportion of Japanese patients with MADIT II-like criteria will experience ventricular arrhythmic events and what clinical factors may predict these events during long-term follow up. The purpose of this study was to investigate mortality, incidence of appropriate ICD therapy administration, and factors influencing ICD therapy in Japanese patients with ICDs for primary prevention who fulfilled the MADIT II criteria.
    Materials and methods
    Results
    Discussion
    Conclusions Our study demonstrated that mortality rate and incidence of appropriate ICD therapy in Japanese patients who fulfilled the MADIT II criteria were identified, and the presence of dilated left ventricle (LVDd≥60mm) and NSVT before ICD implantation could be helpful for further risk stratification of the incidence of VA events.
    Source of funding
    Conflict of interest
    Introduction Atrial fibrillation radiofrequency ablation (AFRA) is useful for controlling the rhythm of atrial fibrillation (AF) [1–3]. However, severe complications rarely occur. Particularly, left atrial–esophageal fistulas (LAEF) caused by ablation energy is a fatal complication because the left atrial wall is adjacent to the esophagus. Patients with LAEF has been reported to have a high mortality [4]. Therefore, preventing esophageal thermal lesions (EsoTLs) caused by AFRA is important, and esophageal temperature monitoring during AFRA has been reported to effectively prevent LAEF [5,6]. A steerable sheath (STS) is gradually brought into widespread use because AF recurrence rate after AFRA was lower when using STS than that when using non-STS [7]. However, the appropriate setting for esophageal temperature monitoring during pulmonary vein isolation remains unclear when STS. The aim of this study was to examine the association between the incidence of EsoTLs and the endoluminal temperature of the esophagus during AFRA, to identify the appropriate temperature for the esophageal temperature-monitoring probe, and how to decrease the incidence of EsoTLs when using the STS.